Treatment providers are often so focused on the needs of the client that they overlook the needs of the families that love him. The challenge for providers is to proceed with an intense level of services while helping the family maintain a sense of security and involvement.
1.  Grief.  The client experiences grief in being separated from his family. The family experiences grief in being separated from their loved one. Shock, denial, pain, guilt, anger, depression, bargaining, loneliness.
Be sure to acknowledge that all family members are experiencing these emotions. Give them permission to experience grief. Assure them the feelings are a normal stage in admitting your loved one to a facility.
2.  Exhaustion. Families are physically and emotional worn out. They are worn out in dealing with the illness, worn out in trying to access funding or services, worn out in balancing treatment needs and daily life, and mentally and emotionally depleted.
Openly and regularly acknowledge the family’s efforts to improve his loved one’s condition. Acknowledge the family’s sacrifice to themselves and other family members. They are weary of telling the story too many times to too many therapists. Encourage them to take care of themselves including eating well, getting exercise, taking time to rest, and resume activities that they formerly enjoyed. Encourage the family to allow the staff to carry some of the burden so the family can get some respite.
3.  Guilt. Families question their own decisions regarding in-home and community based services, always wondering if they’ve done the right thing or if they’ve done enough prior to applying for admission. Families feel a sense of helplessness or hopelessness. The client also feels a sense of guilt which is rarely voiced or acknowledged by anyone. Regarding the family’s attempts to address his needs, the client feels guilt over causing physical and/or emotional hardship on his loved ones.
Assure both parties that no one is to blame. Alleviate blame. Mental illness is no one’s fault. Avoid making statements like, “You couldn’t handle him at home…” or “You are here because you can’t manage yourself at home…” Acknowledge the brain disorder or illness as the root cause for the need of treatment.
4.  Fear of loss. The biggest fear in admitting a loved one to a residential facility is that he may never come out. While the family may finally concede that it’s necessary, they fear losing their love one forever. There is fear of the unknown. Concern engulfs families because they cannot hear or see their loved one daily and don’t know how they are doing. The family fears he may never improve.
Ask the family what their fears are. Address their concerns and follow up with them to assess and re-address their level of security. Assure the family that any separation is temporary.
5.  Feeling left out. Families are confused by the host of professionals that have abruptly invaded their lives. They are confused by the varying roles and loss of control over decision making. Insecurities increase as they feel outnumbered by staff who take over decision making, often without ever consulting the family.
Keep the family in the loop. Connect with them at least weekly to discuss the client’s well being and treatment needs. Unless it is an emergency, involve the family in all decision making. Allow families to meet all treatment providers and explain their roles. Openly acknowledge the encroachment of invasiveness on the family dynamic. Allow families to have support people or family advocates in clinical staffings and other meetings to balance the scales of support.
6.  Oppression. Families feel emotionally beaten down and may hold back from expressing their feelings to staff. The provider runs the risk of shutting them down, limiting their access to information that may help the client. This is especially true when a family has been forced to relinquish a child to state care in exchange for treatment. The family has been threatened by individuals within the child welfare and juvenile justice systems of losing their child, their other children, and possibly having their parental rights terminated completely. Both state systems place heavy demands on the family which serve the needs of state systems rather than the families they serve.
Avoid putting services in place without consulting the client and family first. Respect the family’s choice to decline a service. Offer, but don’t insist. Replace terms like “my child” or “our client” with “your son” or a similarly appropriate term. Consider the uniqueness of each family’s culture and religious preferences. Investigate the individuality of each case and take a family centered approach to treatment. Acknowledge the limitations and injustices of governmental systems in accessing treatment. Ask, listen, discuss the approach with the family, respond, assess, and follow up.
Karl Dennis, former Executive Director of Kaleidoscope Therapeutic Foster Care, in Chicago, reveals the most important thing he learned in all his years of service to families in the Foreward to my book, “Second Time Foster Child.” If he REALLY wanted to know best how to serve his clients, the family would always point the direction services should take. Simply put…
“Families have always been my teachers.”
When treatment providers fail to keep the family unit’s “hope tank” full, they fail to meet the needs of the client.
The client will not get better without the loving support and guidance of his family. Meet the needs of the family unit and you will meet the needs of the client.